Maternal-Fetal Medicine Practice Questions

Q: What are the chances of vertical transmission of Hepatitis B in women who are seropositive for both HBsAg and HBeAg?

90%. **Explanation:** The risk of vertical transmission of Hepatitis B Virus (HBV) is primarily determined by the maternal viral load and serological status. **1. Why 90% is correct:** HBeAg (Hepatitis B envelope antigen) is a marker of active viral replication and high infectivity. When a pregnant woman is positive for both **HBsAg** (indicating infection) and **HBeAg** (indicating high viral load), the risk of vertical transmission to the neonate is approximately **70–90%** in the absence of immunoprophylaxis. Without intervention, about 90% of these infected infants will go on to develop chronic HBV infection. **2. Why other options are incorrect:** * **A & B (25-40%):** These figures are too low for HBeAg-positive mothers. However, if a mother is **HBsAg positive but HBeAg negative** (and anti-HBe positive), the transmission risk drops significantly to about **10–20%**. * **C (60%):** While transmission rates are high, 60% underestimates the synergistic effect of HBeAg positivity on vertical transmission. **3. High-Yield Clinical Pearls for NEET-PG:** * **Timing of Transmission:** Most vertical transmission occurs **intrapartum** (during delivery) due to contact with maternal blood and vaginal secretions. Transplacental (in-utero) transmission is rare ( 200,000 IU/mL (or $10^6$ copies/mL), Tenofovir is recommended starting at 28–32 weeks of gestation to further reduce the viral load. * **Breastfeeding:** It is **not contraindicated** in HBV-positive mothers, provided the infant receives the birth dose of the vaccine and HBIG.

Q: Which of the following is NOT a criterion for expectant management in pre-eclampsia?

Blood pressure > 140/90 mm Hg. In pre-eclampsia, the decision between expectant management and delivery depends on the severity of the disease and the presence of **"Features of Severity."** **Explanation of the Correct Answer:** **Option B (BP > 140/90 mm Hg)** is the correct answer because it is the **baseline definition** of pre-eclampsia, not a contraindication to expectant management. Expectant management is typically considered in stable patients with "Pre-eclampsia without severe features" between 24 to 34 weeks of gestation. A blood pressure of 140/90 mm Hg is mild; only when BP reaches **≥ 160/110 mm Hg** (Severe Hypertension) does it become a criterion to reconsider expectant management or initiate urgent antihypertensive therapy. **Analysis of Incorrect Options (Criteria for Termination/Severe Features):** Expectant management is contraindicated (or must be terminated) if any of the following severe features develop, as they indicate end-organ damage: * **Option A (Platelets < 100,000/ml):** Indicates thrombocytopenia, a sign of HELLP syndrome or worsening coagulopathy. * **Option C (Urine output < 400 ml/day):** Indicates oliguria and impending renal failure. * **Option D (Persistent headache):** Represents cerebral symptoms (neurological involvement) and is a precursor to eclampsia (seizures). **High-Yield NEET-PG Pearls:** * **Definitive Treatment:** The only definitive cure for pre-eclampsia is the delivery of the placenta. * **Expectant Management Goal:** To improve fetal maturity (administer steroids) without compromising maternal safety. * **Absolute Indications for Delivery:** Eclampsia, Abruptio Placentae, Pulmonary edema, DIC, and Non-reassuring fetal heart rate. * **Magnesium Sulfate ($MgSO_4$):** The drug of choice for seizure prophylaxis in severe pre-eclampsia.

Q: A 24-week pregnancy scan revealed frontal facial fetal defects suggestive of Moebius syndrome. Which of the following could account for the teratogenic effects?

Misoprostol. **Explanation:** **Misoprostol** is a synthetic prostaglandin E1 (PGE1) analogue. When used in the first trimester for failed medical abortion, it can cause uterine contractions leading to **vascular disruption** in the developing fetus. This vascular insult (specifically involving the subclavian artery or cranial vessels) results in **Moebius Syndrome**, characterized by congenital paralysis of the 6th (abducens) and 7th (facial) cranial nerves, often associated with limb reduction defects and orofacial malformations. **Analysis of Incorrect Options:** * **Mifepristone (A):** An anti-progestogen used for medical abortion. While it terminates pregnancy by blocking progesterone receptors, it is not specifically linked to the vascular disruption sequence seen in Moebius syndrome. * **Dinoprostone (C):** A PGE2 analogue used primarily for cervical ripening and induction of labor at term. It is not typically associated with first-trimester teratogenicity leading to Moebius syndrome. * **Methotrexate (D):** A folate antagonist. Teratogenicity (Fetal Methotrexate Syndrome) typically presents with "cloverleaf skull," craniosynostosis, wide-set eyes, and limb defects, rather than the specific cranial nerve palsies of Moebius syndrome. **NEET-PG High-Yield Pearls:** * **Moebius Syndrome Triad:** Facial paralysis (mask-like facies), impaired lateral eye movement, and limb deformities (e.g., clubfoot). * **Vascular Disruption Sequence:** The same mechanism (Misoprostol) can also cause **Poland Syndrome** (unilateral absence of pectoralis major and syndactyly). * **Safe Use:** Misoprostol is highly effective for PPH prophylaxis and medical abortion, but patients must be counseled on the teratogenic risks if the pregnancy continues.

Q: Which of the following is the drug of choice for Toxoplasmosis in pregnancy?

Spiramycin. **Explanation:** **Toxoplasmosis in pregnancy** is a critical topic for NEET-PG due to its potential for congenital transmission. The management depends on whether the fetus is infected. **Why Spiramycin is the Correct Answer:** Spiramycin is a macrolide antibiotic and is the **drug of choice for primary prophylaxis** in a pregnant woman with documented acute Toxoplasmosis where fetal infection is not yet confirmed. Its primary mechanism is to concentrate in the placenta, thereby reducing the risk of vertical transmission from mother to fetus by approximately 60%. Importantly, it does not cross the placenta in significant amounts, making it safe for the fetus but ineffective if the fetus is already infected. **Analysis of Incorrect Options:** * **A. Metronidazole:** This is an antiprotozoal/antibiotic used for Trichomoniasis, Bacterial Vaginosis, and anaerobic infections; it has no role in treating Toxoplasmosis. * **B & C. Pyrimethamine and Sulfadiazine:** This combination is the **treatment of choice if fetal infection is confirmed** (via positive amniotic fluid PCR) or if the mother is infected late in the third trimester. However, Pyrimethamine is potentially teratogenic (folate antagonist) and is generally avoided in the first trimester. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad of Congenital Toxoplasmosis:** Chorioretinitis, Hydrocephalus, and Intracranial calcifications (typically diffuse/scattered). * **Transmission Risk:** The risk of transmission increases with gestational age (highest in the 3rd trimester), but the **severity** of fetal damage is greatest if infected in the 1st trimester. * **Diagnosis:** Sabin-Feldman Dye test is the gold standard (though rarely used now); IgM and IgG avidity tests are used clinically. * **Folinic Acid (Leucovorin):** Always co-administer with Pyrimethamine to prevent bone marrow suppression.

Q: On sonography, a multigravida is found to have oligohydramnios. Which among the following will be associated with this condition?

Renal agenesis. **Explanation:** **Understanding the Concept:** Amniotic fluid volume is a dynamic balance between production and removal. After 12–14 weeks of gestation, **fetal urine** becomes the primary source of amniotic fluid, while **fetal swallowing** is the major route of its removal. **Why Renal Agenesis is Correct:** In cases of **Renal Agenesis** (Potter’s Sequence), the kidneys fail to develop, leading to a total absence of fetal urine production. Since the primary source of fluid is missing, it results in severe **oligohydramnios** (Amniotic Fluid Index < 5 cm or Single Deepest Pocket < 2 cm). **Analysis of Incorrect Options:** * **Oesophageal Atresia:** This condition prevents the fetus from swallowing amniotic fluid. Since the removal mechanism is blocked while urine production continues, it leads to **polyhydramnios**. * **Spina Bifida:** Open neural tube defects (NTDs) cause **polyhydramnios** due to the transudation of cerebrospinal fluid into the amniotic sac and impaired fetal swallowing. * **Chorioangioma of Placenta:** This is a vascular tumor of the placenta. Large chorioangiomas (>5 cm) act as arteriovenous shunts, leading to high-output cardiac failure in the fetus, increased fetal urine production, and subsequent **polyhydramnios**. **NEET-PG High-Yield Pearls:** * **Most common cause of oligohydramnios:** Premature Rupture of Membranes (PROM). * **Most common fetal anomaly associated with oligohydramnios:** Renal anomalies (e.g., Posterior Urethral Valves, Polycystic Kidney Disease). * **Potter’s Sequence:** Oligohydramnios → Pulmonary hypoplasia, flattened facies, and limb deformities (clubfoot). * **Drug-induced oligohydramnios:** ACE inhibitors and NSAIDs (due to decreased fetal renal perfusion).

Question 1

A 27-year-old woman, gravida 3 para 2, presents at 37 weeks gestation with no prenatal care. She reports sudden, severe back pain after bending down, which has persisted for 2 hours. Approximately 30 minutes prior to arrival, she noted bright red vaginal bleeding. Upon arrival, she is contracting strongly every 3 minutes with a firm uterus between contractions. Fetal presentation is vertex with the head deeply engaged, and the fetal heart rate is 130/min. Fundal height is 38 cm above the symphysis. Blood for clotting is drawn and forms a clot in 4 minutes, with further studies sent to the laboratory. Which of the following actions can wait until the patient is stabilized?

Accepted Answer

Administering oxytocin

Answer

Stabilizing maternal circulation

Answer

Attaching a fetal electronic monitor

Answer

Inserting an intrauterine pressure catheter

Question 2

What are the chances of vertical transmission of Hepatitis B in women who are seropositive for both HBsAg and HBeAg?

Accepted Answer

90%

Answer

25-30%

Answer

40%

Answer

60%

Question 3

What are the findings in ultrasound suggestive of an incompetent internal os?

Accepted Answer

Cervical length, funneling of amniotic sac, AP length of cervix

Answer

Cervical length, external os, internal os

Answer

Cervical length, funneling of amniotic sac

Answer

External os, internal os

Question 4

Which of the following is NOT a criterion for expectant management in pre-eclampsia?

Accepted Answer

Blood pressure > 140/90 mm Hg

Answer

Platelet count < 100,000/ml

Answer

Urine output < 400 ml/day

Answer

Persistent headache

Question 5

Which of the following is NOT an absolute maternal indication for termination of pregnancy?

Accepted Answer

Parous woman with grade III and IV cardiac lesions

Answer

Eisenmenger's syndrome

Answer

Primary pulmonary hypertension

Answer

Pulmonary veno-occlusive disease

Question 6

A 24-week pregnancy scan revealed frontal facial fetal defects suggestive of Moebius syndrome. Which of the following could account for the teratogenic effects?

Accepted Answer

Misoprostol

Answer

Mifepristone

Answer

Dinoprostone

Answer

Methotrexate

Question 7

Which drug is given as a single dose to prevent mother-to-child HIV transmission?

Accepted Answer

Nevirapine

Answer

Didanosine

Answer

Acyclovir

Answer

Nelfinavir

Question 8

Which of the following is the drug of choice for Toxoplasmosis in pregnancy?

Accepted Answer

Spiramycin

Answer

Metronidazole

Answer

Pyrimethamine

Answer

Sulfadiazine

Question 9

On sonography, a multigravida is found to have oligohydramnios. Which among the following will be associated with this condition?

Accepted Answer

Renal agenesis

Answer

Oesophageal atresia

Answer

Spina bifida

Answer

Cholangioma of placenta

Question 10

What is the most common type of anemia in pregnancy?

Accepted Answer

Microcytic hypochromic anemia

Answer

Megaloblastic anemia

Answer

Microcytic normochromic anemia

Answer

Normochromic normocytic anemia

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?